Mental health promotion in a time of H7N9

By Chang Chueh 張玨

Taiwan has experienced several natural disasters and health emergencies in recent years, such as the 921 Earthquake in 1999, the SARS outbreak in 2003 and Typhoon Morakot in 2009. These calamities have provided us with a lot of experience on the mental health aspect of emergency response work. Nevertheless, an online epidemic prevention booklet from by the Centers for Disease Control (CDC) published in response to the H7N9 avian influenza outbreak does not mention public mental health.

The handbook is intended for a mass readership. It talks about keeping the media informed and getting the message out, and it reminds the public to avoid contact with birds and to take personal protection measures. However, the suggestions focus exclusively on “physical” measures, such as frequently washing one’s hands; covering one’s mouth with a handkerchief, surgical mask or sleeve when sneezing; and seeking prompt medical attention when one feels ill. It advises people who may have the flu to stay home and to contact health authorities and it urges those caring for flu patients to be aware of their own health.

One glaring omission is the question of how people should deal with the worry or fear that arises when an epidemic is evolving. The booklet pays no attention to public reaction to the government’s reports about the H7N9 situation. The psychological trauma that resulted from patients being isolated or ostracized during the SARS outbreak could well be repeated, so it would be wise to learn from the past and think about how to deal with the many mental health issues that arise during a viral epidemic. The booklet could be improved by addressing some important mental health concerns. For example, how are people placed in isolation going to cope with it? And how should their family members go about caring for them?

During the SARS crisis, we established the Mental Health Action Alliance, which proposed some ideas for coping with the fear of infection and the loneliness of isolation. We learned the importance of social support and communities. Support channels for care are crucial. These include families and neighbors, teachers and students, and nearby clinics and welfare departments. In the wake of the SARS outbreak, an evidence-based program of “laughing qigong” not only improved participants’ immunity but, more importantly, increased social support and lessened individual fears and anxieties. The alliance also published literature on coping with SARS-related stress that is available for download and is equally applicable to the H7N9 flu.

The question is, given that the government set up psychological support systems years ago, why has it not reminded people about what is available? When this was pointed out, the government’s response was that there was no need to panic because there had been no cases of H7N9 in Taiwan. Only now that one case has been confirmed has the government begun its support systems. Why did it have to wait until there was a case and people started to panic? The main reason is that there is no high-level and independent government department dedicated to running such a system. The H7N9 situation highlights the dire need for a separate mental health department under the Department of Health.

In the face of widespread fear about H7N9, everyone should keep an eye on the government to ensure it sets up a comprehensive psychological support network. While we need to boost people’s physical immunity, we also need to strengthen their psychological stress management and safeguard their mental health.